|
Zinc Transporter 8 Ab
|
Professional
|
Both
|
$84.45
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
6222161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$83.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.53
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cigna Commercial |
$83.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$79.92
|
| Rate for Payer: HFN Commercial |
$83.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$70.26
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$83.44
|
| Rate for Payer: Quartz Beloit One Network |
$38.64
|
| Rate for Payer: Quartz Commercial |
$50.06
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$96.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: WEA Trust Commercial |
$48.31
|
| Rate for Payer: WPS Commercial |
$107.86
|
|
|
Ziprasidone JW Waste Charge per 10 mg
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS J3486 JW
|
| Hospital Charge Code |
5266680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$120.43
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
Ziprasidone JW Waste Charge per 10 mg
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS J3486 JW
|
| Hospital Charge Code |
5266680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Aetna Managed Medicare |
$56.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.33
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.54
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: NAPHCARE Commercial |
$120.43
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$130.47
|
| Rate for Payer: Quartz Medicare Advantage |
$120.43
|
| Rate for Payer: The Alliance Commercial |
$100.36
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
Ziprasidone JW Waste Charge per 10 mg
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS J3486 JW
|
| Hospital Charge Code |
5266680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$190.68 |
| Rate for Payer: Aetna Commercial |
$190.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$190.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.43
|
| Rate for Payer: Health EOS Commercial |
$182.66
|
| Rate for Payer: HFN Commercial |
$190.68
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: Preferred Network Access Commercial |
$190.68
|
| Rate for Payer: Quartz Beloit One Network |
$88.32
|
| Rate for Payer: Quartz Commercial |
$114.41
|
| Rate for Payer: The Alliance Commercial |
$100.36
|
| Rate for Payer: United Healthcare Medicaid |
$9.52
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
Ziprasidone Level
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
Ziprasidone Level
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.83 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.84
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$111.07
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$111.07
|
| Rate for Payer: The Alliance Commercial |
$92.56
|
| Rate for Payer: United Healthcare PPO |
$138.84
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
Ziprasidone Level
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$175.86 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$175.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.07
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$175.86
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$175.86
|
| Rate for Payer: Quartz Beloit One Network |
$81.45
|
| Rate for Payer: Quartz Commercial |
$105.52
|
| Rate for Payer: The Alliance Commercial |
$92.56
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
ZIPWIRE .035 X 180CM STIFF ANGLED M00146308B0
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.72 |
| Max. Negotiated Rate |
$968.28 |
| Rate for Payer: Aetna Commercial |
$947.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$905.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.81
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$968.28
|
| Rate for Payer: Health EOS Commercial |
$936.71
|
| Rate for Payer: HFN Commercial |
$968.28
|
| Rate for Payer: Multiplan Commercial |
$841.98
|
| Rate for Payer: Preferred Network Access Commercial |
$968.28
|
| Rate for Payer: Quartz Beloit One Network |
$515.72
|
| Rate for Payer: Quartz Commercial |
$631.49
|
| Rate for Payer: WEA Trust Commercial |
$578.86
|
| Rate for Payer: WPS Commercial |
$779.54
|
|
|
ZIPWIRE .035 X 180CM STIFF ANGLED M00146308B0
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.69 |
| Max. Negotiated Rate |
$968.28 |
| Rate for Payer: Aetna Commercial |
$947.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$905.13
|
| Rate for Payer: Aetna Managed Medicare |
$294.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$684.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$526.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$505.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.81
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$968.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.98
|
| Rate for Payer: Health EOS Commercial |
$936.71
|
| Rate for Payer: HFN Commercial |
$968.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$789.36
|
| Rate for Payer: Multiplan Commercial |
$841.98
|
| Rate for Payer: NAPHCARE Commercial |
$631.49
|
| Rate for Payer: Preferred Network Access Commercial |
$968.28
|
| Rate for Payer: Quartz Beloit One Network |
$515.72
|
| Rate for Payer: Quartz Commercial |
$684.11
|
| Rate for Payer: Quartz Medicare Advantage |
$631.49
|
| Rate for Payer: The Alliance Commercial |
$526.24
|
| Rate for Payer: WEA Trust Commercial |
$578.86
|
| Rate for Payer: WPS Commercial |
$779.54
|
|
|
ZIPWIRE ANGLED TIP 0.018 X 180CM M00146232B0
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$87.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.56
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$188.45
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$188.45
|
| Rate for Payer: The Alliance Commercial |
$157.04
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
ZIPWIRE ANGLED TIP 0.018 X 180CM M00146232B0
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
ZIPWIRE ANGLED TIP 035 X 150 STIFF SHAFT M006630206B0/M0066802060
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5179401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$487.34
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
|
ZIPWIRE ANGLED TIP 035 X 150 STIFF SHAFT M006630206B0/M0066802060
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5179401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.43 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Aetna Managed Medicare |
$227.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$527.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$406.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$389.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$454.54
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$609.18
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: NAPHCARE Commercial |
$487.34
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$527.96
|
| Rate for Payer: Quartz Medicare Advantage |
$487.34
|
| Rate for Payer: The Alliance Commercial |
$406.12
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
|
ZIPWIRE STRAIGHT TIP .025 X 150 STIFF SHAFT M006630216B0/M0066802160
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.37 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Aetna Managed Medicare |
$262.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.38
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$702.78
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: NAPHCARE Commercial |
$562.22
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$609.08
|
| Rate for Payer: Quartz Medicare Advantage |
$562.22
|
| Rate for Payer: The Alliance Commercial |
$468.52
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
ZIPWIRE STRAIGHT TIP .025 X 150 STIFF SHAFT M006630216B0/M0066802160
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.15 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$562.22
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
ZIPWIRE STRAIGHT TIP .035 X 150 STIFF SHAFT M0066802220
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.15 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$562.22
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
ZIPWIRE STRAIGHT TIP .035 X 150 STIFF SHAFT M0066802220
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.37 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Aetna Managed Medicare |
$262.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.38
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$702.78
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: NAPHCARE Commercial |
$562.22
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$609.08
|
| Rate for Payer: Quartz Medicare Advantage |
$562.22
|
| Rate for Payer: The Alliance Commercial |
$468.52
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
ZIPWIRE STRAIGHT TIP .038 X 150 STIFF SHAFT M0066802250
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.63 |
| Max. Negotiated Rate |
$931.92 |
| Rate for Payer: Aetna Commercial |
$911.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$871.15
|
| Rate for Payer: Aetna Managed Medicare |
$283.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$506.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$486.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.87
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$931.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$566.87
|
| Rate for Payer: Health EOS Commercial |
$901.53
|
| Rate for Payer: HFN Commercial |
$931.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$759.72
|
| Rate for Payer: Multiplan Commercial |
$810.37
|
| Rate for Payer: NAPHCARE Commercial |
$607.78
|
| Rate for Payer: Preferred Network Access Commercial |
$931.92
|
| Rate for Payer: Quartz Beloit One Network |
$496.35
|
| Rate for Payer: Quartz Commercial |
$658.42
|
| Rate for Payer: Quartz Medicare Advantage |
$607.78
|
| Rate for Payer: The Alliance Commercial |
$506.48
|
| Rate for Payer: WEA Trust Commercial |
$557.13
|
| Rate for Payer: WPS Commercial |
$750.27
|
|
|
ZIPWIRE STRAIGHT TIP .038 X 150 STIFF SHAFT M0066802250
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$496.35 |
| Max. Negotiated Rate |
$931.92 |
| Rate for Payer: Aetna Commercial |
$911.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$871.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.87
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$931.92
|
| Rate for Payer: Health EOS Commercial |
$901.53
|
| Rate for Payer: HFN Commercial |
$931.92
|
| Rate for Payer: Multiplan Commercial |
$810.37
|
| Rate for Payer: Preferred Network Access Commercial |
$931.92
|
| Rate for Payer: Quartz Beloit One Network |
$496.35
|
| Rate for Payer: Quartz Commercial |
$607.78
|
| Rate for Payer: WEA Trust Commercial |
$557.13
|
| Rate for Payer: WPS Commercial |
$750.27
|
|
|
Zonisamide (Zonegran)
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
983444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Zonisamide (Zonegran)
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
983444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$158.86
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: United Healthcare PPO |
$183.30
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: Wellcare Medicare |
$13.78
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Zonisamide (Zonegran)
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
983444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$232.18 |
| Rate for Payer: Aetna Commercial |
$232.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$232.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$222.40
|
| Rate for Payer: HFN Commercial |
$232.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$232.18
|
| Rate for Payer: Quartz Beloit One Network |
$107.54
|
| Rate for Payer: Quartz Commercial |
$139.31
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$54.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$60.63
|
|
|
Zoster Vacc, SC 90736 man
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
3369597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
Zoster Vacc, SC 90736 man
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
3369597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$478.19 |
| Rate for Payer: Aetna Commercial |
$478.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$478.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.02
|
| Rate for Payer: Health EOS Commercial |
$458.06
|
| Rate for Payer: HFN Commercial |
$478.19
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$478.19
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$286.92
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
Zoster Vacc, SC 90736 man
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
3369597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$140.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$327.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.69
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.52
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: Quartz Medicare Advantage |
$302.02
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
